Pancreas concern

I am a 34 yr old female, 2 yr history of gerd and drinking. My father died of pancreatic cancer this summer.

For 1.5 months I have had upper left ab pain and some centered burning. The pain in the left will slightly hit for a minute then go, then come back. I had my ca 19 tested (due to my dad) in Sept 08 (it was slight elevated at 43), then again in Feb 09 (37), then after this pain started which was 4 wks after my Feb test it was 66-so it doubled in 4 wks and is dbl normal. I also had my lipase tested once the pains hit a few times and it has been slightly elevated, will retest again this week.

I had an ab US (I am 105 pds, 5'5-they said ab US can be more accurate in thin people), CT with dye and an EUS at CPMC (no biopsy). All these tests were clear and did not show masses or even inflammation.

1. Should I be concerned that this is pancreatic cancer?

2. How accurate is an EUS?

3. My dr said a CA 19 can be elevated with pancreatitis and other items, not just cancer.

4. If it were pancreatitis, does it present this way (no fevers, throwing up, or having to go to ER for the pain) and could it last for over a month?

For 8 months I have also had nerve pains, muscle twitching, extreme joint cracking and developed horizontal beaus lines all over my nails. However, I had had tons of tests for AI diseases and have been clear.

5. Could it be possible that something else would cause this lipase and ca 19 to be elevated outside of PC or pancreatitis?

6. Would you recommend I get an MRI as well?

Thanks in advance,

[Kevin Pho, MD]

1,2) The CT and endoscopic ultrasound can be reasonable sensitive to diagnose pancreatic cancer.  I can't give specific numbers, as this will depend on the location of the cancer in question, and can affect sensitivity numbers.  An MRI would be an additional test to give more certainty if a pancreatic mass is suspected.

3) Indeed, blood tests are not specific for pancreatic cancer, and yes, there are other conditions that can affect the test.

4) Yes, chronic pancreatitis can lead to the symptoms you describe.  

5) You can consider an upper endoscopy to evaluate for other causes of dyspepsia, such as an ulcer or inflammation of the upper digestive tract.

6) Yes, I do suggest discussing whether an MRI would help with the diagnosis.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin Pho, M.D.
www.kevinmd.com
www.twitter.com/kevinmd